Refer to departmental "Scope of Service" and "Provision of Care" plans, as applicable, for description of primary age groups and populations served by this job for the respective HM entity.
HOUSTON METHODIST EXPERIENCE EXPECTATIONS
Provide personalized care and service by consistently demonstrating our I CARE values:INTEGRITY: We are honest and ethical in all we say and do.COMPASSION: We embrace the whole person including emotional, ethical, physical, and spiritual needs.ACCOUNTABILITY: We hold ourselves accountable for all our actions.RESPECT: We treat every individual as a person of worth, dignity, and value.EXCELLENCE: We strive to be the best at what we do and a model for others to emulate.Practices the Caring and Serving ModelDelivers personalized service using HM Service StandardsProvides for exceptional patient/customer experiences by following our Standards of Practice of always using Positive Language (AIDET, Managing Up, Key Words)Intentionally collaborates with other healthcare professionals involved in patients/customers or employees' experiential journeys to ensure strong communication, ease of access to information, and a seamless experience.Involves patients (customers) in shift/handoff reports by enabling their participation in their plan of care as applicable to the given jobDisplays cultural humility, diversity, equity and inclusion principlesActively supports the organization's vision, fulfills the mission and abides by the I CARE values Responsibilities PEOPLE ESSENTIAL FUNCTIONS
Role models as a preceptor and implements staff education specific to patient populations and unit processes; coaches and mentors other staff. Functions a resource for case management and social work resources and needs for the department and the hospital. Exemplifies/leads teamwork by responding positively to requests for assistance. Fosters staff engagement by demonstrating active listening, requesting and acknowledging feedback, making equitable decisions, providing rationale when appropriate, and supporting organizational.Arranges, expedites and completes acquisition of post-acute care needs or secures insurance authorization, as directed, confirming with social workers and case managers, and ancillary departments, based on physician orders, payor/reimbursement practices and regulations that may impact the patient's plan of care.Facilitates designing and redesigning of CM representative processes and workflow. Actively participates in making recommendations for improving working relationships in the department, hospital, vendors, and post-acute providers. Leads contributions with leadership to identify workflow opportunities, assisting with recruitment and retention efforts, including to improve employee engagement department scores for CM representatives through peer-to-peer accountability.
SERVICE ESSENTIAL FUNCTIONS
Provides necessary transfer/admission documentation. Reviews for accuracy and completion. Supports clerical and clinical functions for patients, physicians and staff. Provides administrative assistance, as needed, including scheduling follow-up appointments or providing clinical updates to payors, as needed Initiates efficiency initiatives for durable medical delivery process.Provides front-line problem resolution to straightforward questions or customer service needs. Provides guidance to payors/ancillary partners and/or CM Representatives on service standards and service recovery. Partners with leadership to implement best practices to deliver unparalleled service.Tracks and trends service failures. Articulates and takes action for service gaps to leadership and along with recommendations for improvement. Collaborates with the leadership team to develop strategies to maximize efficiency and remove barriers to ensure effectiveness of post-acute care referrals or minimize denials or delays.Participates in action plans for transition of care/discharge questions for patient satisfaction. Identifies opportunities to improve the customer experience. Contributes towards improving department scores for patient satisfaction on unit-based scorecard through peer-to-peer accountability.
QUALITY/SAFETY ESSENTIAL FUNCTIONS
Serves as a role models for situational awareness, using teachable moments to improve safety. Contributes to identification of corrective action and improvement activities to meet department and hospital targets for quality and safety, collaborating with the interprofessional health care team.Collaborates with the leadership team to develop opportunities to improve documentation of insurance correspondence and compliance with payors/appeals, distribution of regulatory notices, including the CMS Important Message from Medicare, Medicare Outpatient Observation Notice, etc.
FINANCE ESSENTIAL FUNCTIONS
Proactively secures reimbursement/certification and authorization-related needs, independently and escalates to management if needed. Documents approvals and authorization numbers from payors. Logs communications and provides information to social workers and case managers, business office/patient access, etc. on insurance/managed care benefits and post-acute care needs.Streamlines concurrent insurance denials and/or appeals process, in collaboration with management and nursing staff. Develops and implements best practices to ensure timely and accurate EMR documentation of authorization, approvals, and denials and recommends strategies for improvement.Identifies trends by payor and reports findings to management for further. Provides information to patients/families on insurance/managed care benefits and assesses need for further education by social worker/case manager.Self-motivated to independently manage time effectively and prioritize daily tasks. Provides input into the department resource utilization including capital and operational budget needs as appropriate. Collaborates with the leadership team to determine cost-reduction strategies. Contributes towards department financial targets through timely documentation, minimizing incidental overtime, optimizing efficiency and other areas according to department specifications.
GROWTH/INNOVATION ESSENTIAL FUNCTIONSShares knowledge with CM Representatives of payor/reimbursement practices and regulations that may impact patient's plan of care and confers with care coordinators and social workers to prioritize placement requests.Offers innovative solutions through participation in department projects and shared governance activities. Ensures own career discussions occur with appropriate management. Completes and updates the My Development Plan on an on-going basis.
This job description is not intended to be all-inclusive; the employee will also perform other reasonably related business/job duties as assigned. Houston Methodist reserves the right to revise job duties and responsibilities as the need arises. Qualifications EDUCATION
Associate's degree or two additional years of experience in lieu of degree
WORK EXPERIENCE
Five years experience in service recovery, insurance, case management, or business office-related area, three of which must be in case managementPrevious experience in Case Management, post-acute setting or physician practice License/Certification LICENSES AND CERTIFICATIONS - REQUIRED
N/A KSA/ Supplemental Data KNOWLEDGE, SKILLS, AND ABILITIES
Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluationsSufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or securityAbility to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principlesStrong knowledge of community resourcesAbility to work independently while collaborating with other team members and exercise sound judgment in interactions with physicians, payors, and patients and their familiesAdapts to multiple ongoing priorities with minimal supervision including but not limited to organizing workflows and actively participating in problem-solvingDemonstrates ability to access information both in the department and within the hospital system to support the department and interprofessional health care team as appropriatePossesses expert computer knowledge including electronic health records, i.e., Epic, Microsoft Office (Word, PowerPoint, & Excel) to maintain patient informationStrong knowledge of Medical TerminologyExcellent telephone, oral and written communication skills, time management and prioritization skillsMust be able to learn new skills effectively
SUPPLEMENTAL REQUIREMENTS
WORK ATTIRE
Uniform NoScrubs NoBusiness professional YesOther (department approved) No
ON-CALL*
*Note that employees may be required to be on-call during emergencies (ie. DIsaster, Severe Weather Events, etc) regardless of selection below.
On Call* No
TRAVEL**
**Travel specifications may vary by department**
May require travel within the Houston Metropolitan area NoMay require travel outside Houston Metropolitan area No Company Profile
Since its founding in 1919, Houston Methodist Hospital has earned worldwide recognition. Houston Methodist Hospital is affiliated with the Weill Medical College of Cornell University and New York-Presbyterian Hospital, one of the nation's leading centers for medical education and research. In 2020, U.S. News & World Report named Houston Methodist Hospital to its top ranked Honor Roll for the fourth time and second consecutive year. 2020 also marked the ninth year in a row Houston Methodist Hospital has been named the No. 1 hospital in Texas. Houston Methodist Hospital directs millions of research dollars into patient care and offers the latest innovations in medical, surgical and diagnostic techniques. With 952 operating beds, 85 operating rooms and over 8,000 employees, Houston Methodist offers complete care for patients from around the world.
The same high-quality care for which Houston Methodist is known is available at several Emergency Care Centers in Houston and the surrounding areas. These Emergency Care Centers house exam rooms, full digital radiography suite, low radiation dose 16-slice CT scan, ultrasound and a full on-site stat chemistry lab.
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Houston Methodist is an Equal Opportunity Employer.
Equal employment opportunity is a sound and just concept to which Houston Methodist is firmly bound. Houston Methodist will not engage in discrimination against or harassment of any person employed or seeking employment with Houston Methodist on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, status as a protected veteran or other characteristics protected by law. VEVRAA Federal Contractor – priority referral Protected Veterans requested. Application FAQs
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